Receiving part for receiving a rod for coupling the rod to a bone anchoring element and a bone anchoring device with such a receiving part

ABSTRACT

A receiving part for receiving a rod for coupling the rod to a bone anchoring element, the receiving part including: a receiving part body having a channel for receiving a rod and defining an accommodation space for accommodating a head of a bone anchoring element, the accommodation space having an opening for inserting the head; and a pressure element at least partially in the accommodation space, the pressure element including a first portion having a recess to receive the rod, and a second portion having a flexible portion to clamp the head, wherein the pressure element is moveable along a longitudinal axis of the receiving part body from an inserting position to insert the head, to a pre-locking position to clamp the head in the receiving part by a pre-stress exerted by the pressure element, to a locking position to lock the head in the receiving part.

CROSS-REFERENCE TO RELATED APPLICATION(S)

This application is a continuation of U.S. patent application Ser. No.14/517,624, filed Oct. 17, 2014, now U.S. Pat. No. 10,182,848, issuedJan. 22, 2019, which is a continuation of U.S. patent application Ser.No. 12/709,375, filed Feb. 19, 2010, now U.S. Pat. No. 8,926,671, issuedJan. 6, 2015, which claims the benefit of U.S. Provisional PatentApplication Ser. No. 61/154,306, filed Feb. 20, 2009, the contents ofwhich are hereby incorporated by reference in their entirety, and claimspriority from European Patent Application EP 09 002 468.8, filed Feb.20, 2009, the contents of which are hereby incorporated by reference intheir entirety.

BACKGROUND Field of the Invention

The invention relates to a receiving part for receiving a rod forcoupling the rod to a bone anchoring element and a bone anchoring devicewith such a receiving part. The receiving part includes a receiving partbody and a pressure element located at least partly in an accommodationspace of the receiving part body. The pressure element has a flexibleportion to clamp the head. The pressure element can assume in thereceiving part body an insertion position in which introduction andremoval of the head is permitted, a locking position in which the headis locked in the receiving part, and a pre-locking position in which thehead is clamped by a pre-stress exerted by the pressure element.

Description of Related Art

Various designs of polyaxial bone screws, wherein the head is clampedfrom the side to lock the rotational position of the bone screw, areknown.

U.S. Pat. No. 5,672,176 describes a bone screw with a receiving partwith a conically shaped seat and a conically shaped pressure elementwhich exerts a pressure onto the head from above and from the side. Ifthe cone angle has a value laying within a specific range self-lockingof the pressure element within the receiving part takes place whichallows to preliminary lock the head within a receiving part while therod is still movable in order to allow the adjustment of its position.

WO 2007/038350 A2 discloses an apparatus for connecting a bone anchor toa support rod, the apparatus including a connector body and a cap. Theconnector body has a socket for insertion, angulation and removal of abone anchor. A sleeve is provided which is configured to fit over theconnector body in a temporary position, in which the sleeve permitsinsertion of the bone anchor, to move to a provisional locking position,in which the sleeve permits angulation but prevents removal of the boneanchor, and to move to a locking position, in which the sleeve preventsboth angulation and removal of the bone anchor.

U.S. Pat. No. 6,063,090 relates to a device used to connect alongitudinal support to a pedicle screw by an accommodating head havinga channel to accommodate the longitudinal support. The pedicle screw andthe accommodating head are connected via a conical collet chuck in theaccommodating head and by a spherical head on the pedicle screw. Thedevice allows engagement of the pedicle screw in the accommodating headafter the pedicle screw has been inserted into the bone.

U.S. Pat. No. 6,132,432 describes a spinal implant fixation assemblyincluding a bone fixation member such as a screw and a rod receivingseat which is operatively connected to the bone fixation element. In oneembodiment a screw head receiving insert is provided, which is movablewithin the assembly between a locked position entrapping the screw headtherein and an unlocked position, wherein the screw head enters orescapes.

SUMMARY

It is an object of the invention to provide an improved receiving partfor receiving a rod for coupling the rod to a bone anchoring element anda bone anchoring device with such a receiving part. The receiving partmay include fewer parts and may be more easily and/or more safelyhandled during surgery.

A pressure element can be arranged in the receiving part body in threepositions. In an insertion position the head is insertable from a bottomof the receiving part body into an accommodation space of the receivingpart body. In a pre-locking position, the pressure element pre-locks thehead in the accommodation space, which prevents inadvertent removal ofthe head from the receiving part body and/or inadvertent movement of thehead with respect to the receiving part body during surgery. This allowsfor safer handling of the bone anchoring device during surgery. In alocking position, the head is finally locked in the receiving part. Thepressure element can be releasably held in the insertion position and/orin the pre-locking position. This makes handling more convenient.

Pre-locking and final locking of the head are achieved with the samepressure element. Hence, the receiving part and the bone anchoringdevice according to embodiments of the invention comprise fewerelements, which reduces the costs for manufacturing and whichfacilitates handling. It makes use of the principle of clamping the headof the bone anchoring element circumferentially from a lateral side,which reduces a force necessary to safely clamp the head. The design ofthe receiving part allows introduction of the head from the bottom ofthe receiving part. Such a design may be more readily utilized when amodular system is provided wherein various bone anchors and/or differentreceiving parts are available prior to surgery.

BRIEF DESCRIPTION OF THE DRAWINGS

Further features and advantages of the invention will become apparentfrom the description of embodiments using the accompanying drawings. Inthe drawings:

FIG. 1 shows a perspective exploded view of a first embodiment of thebone anchoring device.

FIG. 2 shows a perspective view of the bone anchoring device of FIG. 1in an assembled state.

FIG. 3 shows a perspective view of a pressure element according to thefirst embodiment.

FIG. 4 shows a side view of the pressure element of FIG. 3.

FIG. 5 shows a side view of the pressure element shown in FIG. 4 rotatedby 90°.

FIG. 6 shows a cross-sectional view of the pressure element shown inFIG. 5.

FIG. 7 shows a bottom view of the pressure element shown in FIGS. 3 to6.

FIG. 8 shows a cross-sectional view of a bone anchoring device accordingto the first embodiment with a pressure element in a first position, andwhen the bone anchoring element is not yet inserted, the section takenperpendicular to the rod axis.

FIG. 9 shows a cross-sectional view of the bone anchoring deviceaccording to the first embodiment with the pressure element in the firstposition and the bone anchoring element partially inserted.

FIG. 10 shows the bone anchoring device of FIG. 9 with the boneanchoring element fully inserted.

FIG. 11 shows a cross-sectional view of the bone anchoring device of thefirst embodiment with the pressure element in a pre-locking position.

FIG. 12 shows an enlarged view of a detail of FIG. 11.

FIGS. 13a to 13h show various examples of outer and inner cooperatingsurfaces of the pressure element and the receiving part body,respectively.

FIG. 14 shows the bone anchoring device of FIG. 8 with a rod insertedand the head locked.

FIG. 15 shows an exploded perspective view of a bone anchoring deviceaccording to a second embodiment.

FIG. 16 shows an enlarged side view of a pressure element according tothe second embodiment.

FIG. 17 shows a cross-sectional view of the pressure element of FIG. 16.

FIG. 18 shows a side view of the pressure element of FIG. 16 rotated by90°.

FIG. 19 shows a bottom view of the pressure element of FIG. 16.

FIG. 20 shows a cross-sectional view of the bone anchoring deviceaccording to the second embodiment with the pressure element in aninsertion position and the bone anchoring element not yet inserted, thecross-section taken perpendicular to the rod axis.

FIG. 21 shows the bone anchoring device of FIG. 20 with the boneanchoring element fully inserted.

FIG. 22 shows the bone anchoring device of FIG. 20 with the pressureelement in a position just before a pre-locking position.

FIG. 23 shows the bone anchoring device of FIG. 20 with the pressureelement in the pre-locking position.

FIG. 24 shows an enlarged view of a portion of FIG. 23.

FIG. 25 shows an enlarged view of another portion of FIG. 23.

FIG. 26 shows the bone anchoring device of FIG. 20 with the pressureelement in the locking position and the head locked.

DETAILED DESCRIPTION OF THE INVENTION

As shown in FIGS. 1 and 2, a bone anchoring device according to a firstembodiment comprises a bone anchoring element 1 in the form of a bonescrew having a threaded shaft 2 and a head 3, which is in thisembodiment a spherical segment-shaped head. The head 3 has a recess 4for engagement with a screwing-in tool. The bone anchoring devicefurther comprises a receiving part body 5 for receiving a rod 6 toconnect the rod 6 to the bone anchoring element 1. Further, a closureelement 7 in the form of an inner screw is provided for securing the rod6 in the receiving part body 5. In addition, the bone anchoring deviceincludes a pressure element 8 for locking the head 3 in the receivingpart body 5. The pressure element 8 is held in the receiving part body5, for example via pins 9 a, 9 b.

The receiving part body 5 is now explained with reference to FIGS. 1 and8 to 14. The receiving part body 5 comprises a first end 10 and a secondend 11 opposite the first end and an axis of symmetry M passing throughthe first end and the second end. A bore 12 is provided which is coaxialwith the axis of symmetry M. In a first region adjacent to the first end10, the receiving part body 5 has a U-shaped recess 13, which issymmetric with respect to the axis of symmetry M, the recess 13 having abottom directed towards the second end 11 and two free lateral legs 14a, 14 b extending towards the first end 10. In the region of the legs 14a, 14 b an internal thread 15, which cooperates with the inner screw 7,is provided. A channel formed by the U-shaped recess 13 is sized so asto receive the rod 6 therein, the rod to connect a plurality ofanchoring devices. At a second region near the second end 11, acylindrical portion of the bore 12 is followed by a first taperedportion 16 tapering towards the second end 11 with a cone angle. Thefirst tapered portion 16 is followed by a second tapered portion 17tapering towards the second end 11 with a cone angle smaller than thecone angle of the first tapered portion. An opening 18 is provided atthe second end 11. A diameter of the opening 18 is larger than adiameter of the head 3 and smaller than the inner diameter of the bore12. The coaxial bore 12 provides an accommodation space 19 for the screwhead 3.

On each leg 14 a, 14 b, bores 20 a, 20 b extending through the legs 14a, 14 b are provided for receiving the pins 9 a, 9 b. The bores 20 a, 20b are located approximately at a center of each leg.

As can be seen in FIGS. 1 and 3 to 7, the pressure element 8 includes afirst portion 81, which is substantially cylindrical and which has anouter diameter which is slightly smaller than the inner diameter of thebore 12, so that the pressure element 8 is movable in the bore 12, and asecond portion 82 which is recessed with respect to the first portionand which has a maximum outer diameter which is smaller than the innerdiameter of the bore 12. The first portion 81 has at its end opposite tothe second portion 82 a U-shaped recess 83 for receiving the rod 6therein when the pressure element 8 is situated in the receiving partbody 5. At the lateral sides of the U-shaped recess the pressure elementcomprises two elongate recesses 84 in the outer wall which are arrangedopposite to each other, and which are aligned such that a longer side ofthe elongate recesses 84 is parallel to the axis of symmetry M of thereceiving part body 5. As can be seen in FIG. 4, the width of thelateral sides of the first portion 81 decrease towards the end oppositeto the second portion 82 for at least a part of the first portion 81.

The second portion 82 is formed similar to a collar, and comprises afirst end at the side of the first portion 81 which is recessed withrespect to the first portion 81 and a second end, and a hollow interior85 which is substantially spherically shaped to clamp the spherical head3 therein. The second end of the second portion 82 has an opening 86 forintroduction of the head 3. An outer wall of the second portion 82comprises a first portion 87 which is spherical and a second portion 88adjacent to the opening 86 which is tapered. The tapered portion 88 ofthe pressure element cooperates with the second tapered portion 17 ofthe receiving part body. The second portion 82 of the pressure elementfurther comprises a plurality of slits 89 extending from an edge of theopening 86 through the second portion 82. The number and dimensions ofthe slits 89 are such that the wall of the second portion is flexibleenough to snap onto the head 3 when the head 3 is being inserted.Further, the pressure element comprises a coaxial bore 90 for providingaccess to the screw head 3 by a tool.

As can be seen in FIGS. 8 to 14, since the pressure element has amaximum outer diameter which is slightly smaller than the inner diameterof the bore 12, it can be inserted from the first end 10 of thereceiving part body 5 into the receiving part body 5. Once the pressureelement 8 is inserted, the pins 9 a, 9 b are introduced in the bores 20a, 20 b so that they engage in the elongate recesses 84, thereby holdingthe pressure element 8 in the receiving part body 5 and with theU-shaped recess 83 aligned with the U-shaped recess 13 of the receivingpart body 5, and preventing escaping of the pressure element through thefirst end 10. Since the second portion 82 of the pressure element 8 hasan outer diameter which is smaller than the inner diameter of the bore12, and since the second portion 82 of the pressure element has aflexible outer wall, the second portion can expand within theaccommodation space 19 when the screw head 3 is introduced.

All parts described before may be made of a bio-compatible material,such as a bio-compatible metal like stainless steel or titanium, or abio-compatible metal alloy, for example, nitinol, or are made from abio-compatible plastic material, for example, PolyEtherEtherKetone(PEEK).

The steps of assembling the bone anchoring device are now explained withrespect to FIGS. 8 to 14. First, when the pressure element 8 isintroduced into the receiving part body 5 and held by the pins 9 a, 9 b,it is oriented such that the opening 86 is directed towards the secondend 11 of the receiving part body 5. As shown in FIG. 8, the pressureelement 8 is in its uppermost position which is an insertion positionfor allowing the screw head 3 to be inserted. In the insertion position,the flexible second portion of the pressure element is positioned freelyin the accommodation space 19. The insertion position is limited againstupward movement by an abutment which is in this embodiment provided bythe engagement of the pins 9 a, 9 b with the lower end of the recesses84. As shown in FIG. 9, the screw head 3 is then inserted through theopening 18 into the accommodation space 19, where the second portion 82of the pressure element 8 is located. The screw head 3 is introducedinto the hollow interior 85 of the second portion 82 of the pressureelement through the opening 86. Due to the flexibility of the wallprovided by the slits 89, the second portion 82 expands in theaccommodation space 19 as shown in FIG. 9. The second portion 82 snapsonto the screw head 3 until it encompasses the screw head 3 as shown inFIG. 10. The pins also prevent the pressure element 8 from escapingthrough the open first end 10 when the screw head 3 is inserted. In theinsertion position the screw head 3 is pivotable in the receiving partand also removable if the pressure element remains in this position.There may be means (not shown) for holding the pressure elementtemporarily in the insertion position. Alternatively, the pressureelement can be held in the insertion position by means of a tool (notshown).

FIGS. 11 and 12 show a pre-locking position of the pressure element.When the screw head 3 is inserted and the pressure element 8 is presseddown slightly, the outer wall of the second portion 82 of the pressureelement is guided by the first tapered portion 16, so that it contactsthe second tapered portion 17 of the receiving part body. The taperedportion 88 of the outer wall of the pressure element 8 and the taperedportion 17 of the receiving part body 5 come into engagement, whereby apre-stress is exerted by the second portion 82 of the pressure elementonto the screw head 3, which pre-locks the head 3. Pre-locking meansthat under conditions arising during surgery, an angular position of thebone anchoring element 1 with respect to the receiving part body 5 ismaintained and can be loosened only by exerting an additional force ontothe receiving part body or the bone anchoring element. The pre-lockingposition of the pressure element can be achieved either manually bypushing down the pressure element, or by inserting the rod and screwingin the inner screw 7 so that the rod presses onto the pressure elementthereby moving it slightly downwards.

FIGS. 13a and 13b show the engagement of the outer surface portion ofthe pressure element and the inner surface portion of the receiving partbody in the pre-locking condition. As described before, the surfaces 17,88 can be tapered as shown in FIG. 13a . Alternatively to, or inaddition to, tapered surfaces, portions of the surfaces 88′, 17′ can berounded as shown in FIG. 13b . The first tapered portion 16 at thereceiving part body 5 serves only for guidance in some embodiments andcan be omitted.

FIGS. 13c to 13h schematically show various examples of engagements ofthe outer surface portion of the pressure element and the inner surfaceportion of the receiving part body. In FIG. 13c the two tapered portions17, 88 are tapered at substantially a same angle. This provides asubstantially even pressure distribution (approximated by arrows)between the second portion 88 of the pressure element and the taperedportion 17 of the receiving part body. FIGS. 13d and 13e show twodifferent variations where the portions are tapered at different angles.FIG. 13d shows a main contact area at the bottom of portion 17″ and FIG.13e shows a main contact area at the top of portion 17′″. FIG. 13f showsa tapered portion 88″″ of the pressure element and a rounded or curvedportion 17″″ of the receiving part body, wherein the curvature isdirected towards the center of the receiving part body. With such aconfiguration, a focused contact area at the rounded portion can beachieved.

In FIGS. 13g and 13h the narrowing portion 170 of a modified example ofthe receiving part body 5 has a double spherical radius formed by twocurved portions 170 a and 170 b adjacent to each other with a groove 170c therebetween. The curvatures are directed to a central axis M. Amodified pressure element 180 has at its lower end two correspondinglycurved portions 180 a and 180 b which correspond to the curved portions170 a and 170 b, with a crest 180 c therebetween, and an outer crest 180d at an outer edge of the pressure element 180.

As shown in FIG. 13g , when the pressure element 180 moves downwards,its lowermost edge 180 d engages in the groove 170 c. In this position,there is a frictional clamping of the head 3, which still allows thehead 3 to be pivoted upon exertion of a force which is greater than theforce needed to pivot the head 3 when the head 3 is introduced in theinsertion position. This is an example of the pre-locking condition. Asshown in FIG. 13h , by pressing the pressure element 180 furtherdownward, the respective curvatures 180 a, 180 b of the pressure element180 engage with the corresponding curvatures 170 a, 170 b of thenarrowing portion 170 to lock the head 3.

The third position of, for example, the embodiment of FIG. 8, which is alocking position, is shown in FIG. 14. The locking position is definedas the position in which the screw head 3 is locked in the receivingpart body 5. In this position, the tapered outer surface portion 88 ofthe pressure element engages the second tapered portion 17 of thereceiving part body over a larger area. Thereby, the flexible wall ofthe second portion 82 of the pressure element 8 is pressed onto the head3 so that the head 3 is locked. This position is achieved by furthertightening the inner screw 7, thereby further pressing down the rod 6.

In use, the bone anchoring device can be, for example, pre-assembled insuch a way that a suitable bone anchoring element 1 is selected andintroduced into the receiving part body 5 with an inserted pressureelement 8. The bone anchoring device can be brought into the pre-lockingcondition by slightly pushing down the pressure element 8. Then, thescrew element 1 is screwed into the bone. The recess 4 of the head 3 canbe accessed with a screw tool through the coaxial bore 12 and the bore90. To correctly align the receiving part with respect to the rod towhich it shall be connected, an additional force is exerted onto thereceiving part either manually or by application of an instrument. Oncea desired position of the rod with respect to other bone anchoringdevices is achieved, the inner screw 7 is tightened, thereby shiftingdown the pressure element into the locking position. A final tighteningof the inner screw locks the rod and the head substantiallysimultaneously.

The bone anchoring device can be pre-assembled either by themanufacturer or in the course or preparation of surgery, or at any othertime. In one embodiment, the surgeon can select the desired receivingparts and bone anchoring elements prior to surgery according to specificdetails of the particular clinical application. The design of the boneanchoring device allows selection of an appropriate bone anchoringelement in terms of diameter, length, and other features. Hence, amodular system is provided which includes various receiving parts andseveral bone anchoring elements, which then individually can be chosenand adapted.

A second embodiment of the bone anchoring device is now described withrespect to FIGS. 15 to 26. Parts which are similar to those of the firstembodiment have the same reference numerals, and the descriptionsthereof will not be repeated. The second embodiment of the boneanchoring device differs from the first embodiment in the design of thepressure element and the pins. The first portion 81′ of the pressureelement 8′ differs from the first portion 81 of pressure element 8. Thefirst portion 81′ of the pressure element 8′ has a shallow recess 83′which is curved in a substantially cylinder segment shape for guidingthe rod 6. It further includes two upstanding resilient fingers 91 a, 91b extending from respective lateral sides of the recess 83′ in thedirection of the first end 10 of the receiving part body. The fingers 91a, 91 b have outwardly directed portions 92 at their free ends,respectively. An outer diameter of the first portion 81′ at least in theregion of the fingers, is smaller than the inner diameter of the bore ofthe receiving part body, such that the resilient fingers 91 a, 91 b canmove.

Pins 9 a′, 9 b′ each have a flattened portion 93, a width of which issubstantially the same as a width of the outwardly extending portions 92of the resilient fingers 91 a, 91 b. When the pins 9 a′, 9 b′ areinserted into the bores 20 a, 20 b, the portions 93 extend into thecoaxial bore 12 of the receiving part body 5 as shown in FIG. 20. Inthis manner, an abutment is provided for the receiving part 8′.

The assembly of the bone anchoring device according to the secondembodiment is explained with respect to FIGS. 20 to 25. In FIG. 20,first, the pressure element 8′ is inserted from the first end 10 intothe receiving part body 5. Then the pins 9 a′, 9 b′ are inserted intothe holes in the legs. The pressure element 8′ is in such a positionthat the outwardly extending portions 92 of the resilient fingers 91 a,91 b are located above the flattened portions 93 of the pins 9 a′, 9 b′.In this position the pressure element 8′ is in an insertion position.Then, the screw head is inserted through the openings 18 and 86 untilthe second portion 82 of the pressure element 8′ is around the screwhead 3. Then, as shown in FIG. 22, the pressure element 8′ is movedslightly downward to enter a pre-locking position. Here, the resilientfingers 91 a, 91 b are first pressed inwards for the outwardly extendingportion 92 to move past the flattened portion 93 of the pins. As shownin FIG. 23, the outwardly extending portions 92 then move outward andthe flattened portions 93 form an abutment for the pressure element. Inthis pre-locking position, the tapered outer surface portion of thesecond portion 82 engages the tapered portion 17 of the receiving partbody. Since the pins 9 a′, 9 b′ act as a stop, the pre-locking positionis secured (i.e., the pressure element 8′ does not move back to theinsertion position).

Inserting the rod and screwing in the inner screw 7 moves the pressureelement further down until it achieves a final locking position as shownin FIG. 26.

The clinical use of the bone anchoring device is similar to that of thefirst embodiment.

Further modifications of the embodiments shown are possible. Forexample, the head of the bone anchoring element can have any othershape, for example, a cylindrical shape whereby a monoaxial bone screwis provided allowing rotation of the screw element with respect to thereceiving part around a single axis. The head 3 can also be, forexample, conically shaped, where the hollow interior portion 85 of thepressure element is adapted to this shape. In a further modification,the receiving part body 5, or at least the second portion 82 of thepressure element, is made of a bio-compatible plastic material whichprovides elasticity to a certain degree. In this case, the slits may beomitted.

Alternatively to the second embodiment a spring portion can be provided,for example in the receiving part body, which may cooperates with aportion of the pressure element. Generally, the pins are only oneexample of achieving an abutment for the pressure element. Otherconstructions such as snap rings or various other features may also beutilized.

In one embodiment, the receiving part body can have an inclined open endto allow a greater angulation of the head in one direction.

In one embodiment, the outer surface of the second portion 82 of thepressure element can be tapered, and the second tapered portion 17 ofthe receiving part body can be inwardly curved.

While the present invention has been described in connection withcertain exemplary embodiments, it is to be understood that the inventionis not limited to the disclosed embodiments, but is instead intended tocover various modifications and equivalent arrangements included withinthe spirit and scope of the appended claims, and equivalents thereof.

What is claimed is:
 1. A bone anchoring device comprising: a boneanchoring element having a shaft and a head; and a receiving part forreceiving a rod for coupling the rod to the bone anchoring element, thereceiving part comprising: a receiving part body having a channel at afirst end for receiving the rod, and defining an accommodation space ata second end opposite the first end for accommodating the head of thebone anchoring element; and a monolithic pressure element positionablein the receiving part body, the pressure element comprising a firstportion configured to extend into the channel to contact the rod, and asecond portion having a compressible portion to accommodate and clampthe head, wherein a region of the second portion that extendscircumferentially around the pressure element adjacent to the firstportion is recessed with respect to the first portion, and wherein whenthe head is spaced apart from the second portion, an outer diameter ofat least part of the second portion increases as the second portionextends away from the first portion; wherein when the pressure elementis in the receiving part body, the head of the bone anchoring element isinsertable into the receiving part, and the pressure element is movableto a pre-locking position wherein the head is restricted from beingremoved from the receiving part while a first surface of the pressureelement that faces upwards towards the first end of the receiving partbody engages the receiving part body to restrict the pressure elementfrom moving towards the first end of the receiving part body; andwherein the pressure element is movable from the pre-locking positionaway from the first end of the receiving part body to a locking positionwherein a compressive force is exerted on the compressible portion tolock an angular position of the head of the bone anchoring elementrelative to the receiving part.
 2. The bone anchoring device of claim 1,wherein the compressible portion of the pressure element is alsoexpandable for inserting the head of the bone anchoring element.
 3. Thebone anchoring device of claim 1, wherein in the pre-locking position,the outer surface of the second portion of the pressure element engagesan inner surface of the receiving part body.
 4. The bone anchoringdevice of claim 1, wherein the pressure element is held in thepre-locking position by a spring force.
 5. The bone anchoring device ofclaim 4, wherein the spring force is generated by a spring portion onthe pressure element which cooperates with an abutment on the receivingpart body.
 6. The bone anchoring device of claim 1, wherein a portion ofthe receiving part body that defines the accommodation space issubstantially cylindrical and has a narrowing portion that narrowstowards an opening at the second end of the receiving part body.
 7. Thebone anchoring device of claim 6, wherein the pressure element comprisesa narrowing portion on the outer surface that narrows in a directionaway from the first portion of the pressure element and that isconfigured to cooperate with the narrowing portion of the receiving partbody.
 8. The bone anchoring device of claim 1, wherein the compressibleportion of the pressure element has a hollow section for accommodatingthe head of the bone anchoring element and an opening for inserting thehead.
 9. The bone anchoring device of claim 1, wherein an outer diameterof the compressible portion is smaller than an inner diameter of aportion of the receiving part body that defines at least part of theaccommodation space.
 10. The bone anchoring device of claim 1, whereinthe second portion of the pressure element has a smaller maximum outerdiameter than a maximum outer diameter of the first portion of thepressure element.
 11. The bone anchoring device of claim 1, wherein thechannel is a U-shaped recess for receiving the rod.
 12. The boneanchoring device of claim 1, wherein the pressure element is securedfrom removal from the receiving part body.
 13. The bone anchoring deviceof claim 1, further comprising: the rod; and a closure element forsecuring the rod in the receiving part.
 14. The bone anchoring device ofclaim 1, wherein an end of the second portion of the pressure elementadjacent the first portion of the pressure element has an outer diameterthat is recessed with respect to an outer diameter of the first portion.15. The bone anchoring device of claim 1, wherein a part of the firstportion of the pressure element that is configured to extend into thechannel to contact the rod includes a second surface that faces upwardstowards the first end of the receiving part body, and wherein the secondportion of the pressure element is spaced apart axially from the secondsurface.
 16. The bone anchoring device of claim 1, wherein at least partof the pressure element has a continuous exterior surface portionforming a ring.
 17. The bone anchoring device of claim 1, wherein thefirst surface of the pressure element is at a free end of the firstportion of the pressure element.
 18. A method of coupling a rod to abone via a bone anchoring device comprising a bone anchoring elementhaving a shaft and a head, and a receiving part comprising a receivingpart body having a channel at a first end for receiving the rod, anddefining an accommodation space at a second end opposite the first endfor accommodating the head of the bone anchoring element, a monolithicpressure element comprising a first portion configured to extend intothe channel to contact the rod, and a second portion having acompressible portion to accommodate and clamp the head, wherein a regionof the second portion that extends circumferentially around the pressureelement adjacent to the first portion is recessed with respect to thefirst portion, and wherein when the head is spaced apart from the secondportion, an outer diameter of at least part of the second portionincreases as the second portion extends away from the first portion, anda closure element, wherein when the pressure element is in the receivingpart body, the head of the bone anchoring element is insertable into thereceiving part, the method comprising: inserting the bone anchoringelement into a bone; adjusting an angular position of the receiving partrelative to the bone anchoring element when the head and the pressureelement are in the receiving part body and when the pressure element hasbeen moved to a pre-locking position wherein the head is restricted frombeing removed from the receiving part while a first surface of thepressure element that faces upwards towards the first end of thereceiving part body engages the receiving part body to restrict thepressure element from moving towards the first end of the receiving partbody; inserting the rod into the channel of the receiving part body; andadvancing the closure element in the channel to push the rod against thepressure element to move the pressure element from the pre-lockingposition away from the first end of the receiving part body to a lockingposition wherein a compressive force is exerted on the compressibleportion to lock the rod and the angular position of the head of the boneanchoring element relative to the receiving part.